A massive crisis of confidence is unfolding among nurses and clinicians in hospitals around the nation. As more and more COVID-19 patients arrive in emergency rooms, health care workers are terrified. A critical lack of personal protective equipment — masks, N95 respirator masks, and powered air purifying respirators — makes our jobs not just difficult, but dangerous. The consequences of this failure to protect health care workers will be substantial. While it may take years to train a physician or nurse, it may take only a single exposure to kill one.
These are drastic words, but as doctors we believe it is critical to speak up about how current supply chain and mitigation policies are affecting health care workers and patients. Here are some stories we heard from colleagues around the country:
▪ A friend is starting soon as the attending intensive care physician overseeing a dedicated COVID-19 intensive care unit. There will be no powered-air purifying respirator for her. She has tried for weeks to be fit-tested for an N95 — standard practice in hospitals — and was told she would be fitted “when the time comes.” The time has not come, yet she will be taking care of COVID-19 patients. She has updated her will and plans to sleep in the basement to avoid exposing her family.
▪ An operating room nurse has taken the sterile paper wrapping — which is normally discarded — from surgical instrument trays and is sewing surgical masks at home. Not just for herself, but for all the other nurses, surgical technologists, surgeons, and anesthesiologists.
▪ A recovery room nurse shared how she received a patient who was transferred from another hospital for an emergency procedure with no communication from the other facility. She examined him and noticed he had a fever and an oxygen saturation level of 61 percent. The recovery room team quickly intubated him, and the patient is now in a COVID-19 unit. Because a test wasn’t readily available, it is unclear if the patient had sepsis from a urinary tract infection or COVID-19.
It is only a question of time until physicians and nurses start calling in sick. This is a very human reaction, but also a tragedy. We are the medical experts; we know how infectious diseases work. We should feel safe.
We don’t because around the nation, masks, goggles, and respirators are being rationed. N95 respirators are placed in brown paper bags for use the next day.This week, the hashtag #GetUSPPE and moveon.org petitions began trending on social media as desperate health care workers tried to crowd source equipment they urgently need. The US Centers for Disease Control and Prevention has recommended health care personnel use of bandanas and scarves as a last resort.
Health care workers deserve better. Partners HealthCare, where we both operate as surgeons, just issued a new policy stating that all employees need to wear surgical masks on premises. That’s an important first step. Now hospitals all around the country need to get PPE to their staff. Immediately.
There also needs to be clear procedures in place instead of letting clinicians interpret guidelines on the fly. How do we transfer COVID-19 patients from the emergency department to the operating room to the ICU? How do we intubate COVID-19 patients without exposing others in the room? Paper policies are not enough.
To those making decisions about how to respond to the pandemic, we ask you — walk a mile in our shoes. Imagine what it’s like to intubate a distressed patient, and all you have is a thin paper mask.
President Trump recently announced that 500 million N95 respirators would be delivered, which initially gave us hope. But it may take an estimated 18 months for these masks to arrive. By then, the battles will have been won or lost. We need a coordinated national strategy to face this challenge immediately. The federal government must set up a management structure for effective PPE production and distribution. This would mean invoking the Defense Production Act to require domestic manufacturers to ramp up current production, extend purchase guarantees to domestic manufacturers to support our domestic manufacturers, and to generate these orders today.
Clinicians are ready to meet the challenge of COVID-19. We have trained and worked for years to aid the sick and dying in times of crisis. Health care workers are an invaluable resource in this pandemic. We are not expendable.
Dr. Regan Bergmark is a surgeon at the Center for Surgery and Public Health at Brigham and Women’s Hospital and Harvard Medical School. Dr. Thomas Tsai is a surgeon at the Center for Surgery and Public Health at Brigham and Women’s Hospital and at the Harvard Global Health Institute at Harvard Medical School.
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